The purpose of this proposed career development award is to support Dr. Nancy Pandhi, a family physician, in establishing a health services research program centered on effective clinical practice redesign for vulnerable older adults. This award will facilitate Dr. Pandhi's transition to independence as a health services researcher. The proposed training program contains specific benchmarks towards the achievement of six core competencies (statistics and study design, responsible conduct of research, scientific writing, teaching and presentation, leadership/management, and excellence in research) required for success as an independent researcher. The University of Wisconsin-Madison offers an ideal environment for the proposed work as it provides access to accomplished researchers with a proven track record of mentoring physician-scientists and extensive resources to support the proposed work. The specific aims of the proposed project are: 1)To determine if continuity of care with an individual physician has an effect over and above continuity with a site on health care, health outcomes and costs for older adults, 2) To characterize vulnerability using a resource-based framework and then determine if this approach improves our understanding of how continuity with a physician and site affects older adults' health outcomes, and 3) To determine the effect of distinct aspects of continuity of care with a physician (e.g. trust) and site on older adults' health care and health outcomes. Dr. Pandhi will achieve these aims by performing primary data collection on aspects of continuity of care. She also will analyze multiple waves of previously collected data from the Wisconsin Longitudinal Survey (WLS), taking full advantage of the over fifty years of longitudinal data available for analysis of vulnerability. She will analyze health care costs by linking the WLS to Medicare claims data. The long-term goal of this research is to develop and implement a redesigned medical home with optimal continuity of care supporting vulnerable older adults' health. Dr. Pandhi's proposed research directly addresses NIA's goals of developing] strategies to improve the interaction of older people with the health system and for understanding] health differences and health inequities among older adults. RELEVANCE (See instructions): The proposed focus on vulnerability and which older adults benefit most from continuity will provide information essential to developing practice structures that effectively provide care for older adults most at risk for negative outcomes. The results from the proposed research will have implications for physician practices as they seek to redesign themselves into an effective medical home.